Futility policies: Part of the culture of death
Over the past decade many articles in legal, ethical and medical journals have argued for a new concept in health care and in treatment decisions called "medical futility." At least a couple of Catholic health-care systems have involved themselves at the forefront of the implementation of these dubious medical futility policies. Part of the problem lies in the lack of agreement about what "medical futility" actually means.
In terms used by its proponents, medical futility means that a physician can refuse to provide a patient with treatment that he or she does not believe to be useful for the patient. After years of promoting the patient's autonomy in health-care decisions, now, with medical futility, some ethicists argue for a limitation on the patient's decision-making power.
Two authors, Father Peter Clark and Catherine Mikus, working for a Catholic health-care system in Pennsylvania, have subtly argued that physicians should ignore a patient's request for treatment when it conflicts with the physician's judgment. Anticipating reticence on the part of physicians due to the legalities, they write, "If the physician has acted according to generally accepted medical standards and/or in conformance with the expressed wishes of the patient, the physician will generally prevail (in subsequent litigation)."
These authors argue that when patients make irrational requests for treatment the physician should refuse. Of course physicians should not be required to provide medical interventions that offer no medical benefit. But that is not what the current theory of medical futility is about or what the authors mean by irrational. According to the principles of medical fulitity, proponents are seeking to terminate treatment precisely because it actually does sustain life. To put it in the words of anti-euthanasia task force lawyer Wesley Smith, "It isn't the treatment that is deemed futile but, in effect, the patient."
Medical futility policies seem acceptable until one grasps the transformation of words to mean things which most of us would not take them to mean ordinarily. For example, authentic Catholic moral teaching accepts the idea that, in order to be required, treatment should have a benefit. But Father Clark and Mikus state plainly, based on the principle of beneficence, that "treatment that merely preserves permanent unconsciousness or is incapable of ending dependence on critical care should also be considered futile. In judging futility physicians must ... distinguish between an effect (which is limited to a part of the patient's body) and a benefit (which appreciably improves the patient as a whole)." As Wesley Smith points out, "Treatments withheld under this policy might include antibiotics to treat infection, medicines for fever reduction, tube feeding and hydration, kidney dialysis or ventilator support." Persons will certainly dehydrate or die of an infection when water or antibiotics are withheld. But for Clark and Mikus, to intervene medically in such cases is "only to prolong a seemingly meaningless life."
Catholic institutions should resist medical futility policies, seeing them as another deceptive contrivance of the culture of death. Those who do adopt such policies should provide prospective patients and their families with clear notice that they are departing from the authentic principles of Catholic moral teaching and the Hippocratic principle which precludes doing harm to the patient. Once medical futility becomes the standard in health care, a poor prognosis, which can be erroneous and is seldom precise, will become a death sentence.
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